ORIGINAL ARTICLE

Intracranial pressure and cerebral blood flow velocity in preterm infants with posthaemorrhagic ventricular dilatation

W J Maertzdorf¹, J S H Vles², E Beuls³, A L M Mulder¹, C E Blanco¹

¹ Department of Neonatology, University Hospital Maastricht, Maastricht, The Netherlands
² Department of Child Neurology, University Hospital Maastricht
³ Department of Neurosurgery, University Hospital Maastricht

Correspondence to:
Correspondence to:
Dr Maertzdorf, Department of Paediatrics, Academic Hospital Maastricht, PO 5800, 6202 AZ Maastricht, The Netherlands;
wma{at}skin.azm.nl

Aim: To determine the volume of cerebrospinal fluid (CSF) that should be tapped in preterm infants with posthaemorrhagic ventricular dilatation as guided by intracranial pressure (ICP) and cerebral blood flow velocity (CBFV).

Methods: The total number of measurements was 106 in 22 infants. Birth weights ranged from 630 to 2050 g, gestational age from 24.5 to 30.3 weeks, and age at insertion from 12 to 67 days. A subcutaneous ventricular catheter reservoir for repetitive CSF drainage was placed when the diameter of a ventricle was > 4 mm above the 97th centile. A volume of 5 ml/kg body weight was removed twice daily. ICP and CBFV were determined before and after CSF tapping.

Results: If the ICP after tapping exceeded 7 cm H₂O, tapping did not result in a significant improvement in CBFV. If the ICP before tapping was less than 6 cm H₂O, tapping also had no effect on CBFV. Longitudinal studies in individual infants showed a slight correlation between ICP and CBFV.

Conclusion: Volume of repetitive CSF drainage in preterm infants with posthaemorrhagic ventricular dilatation guided by ICP and CBFV may be a useful technique. An ICP of about 6 cm H₂O is the cut off point for CSF drainage.

Keywords: preterm; hydrocephalus; intracranial pressure; cerebrospinal fluid drainage

Abbreviations: PHVD, posthaemorrhagic ventricular dilatation; ICP, intracranial pressure; CSF, cerebrospinal fluid; CBFV, cerebral blood flow velocity; EDFV, end diastolic flow velocity; MFV, mean flow velocity; RI, resistance index

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